Bruce Robert Mirvis, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35.039260 Issued in OH

Practice address

1070 Polaris Pkwy
Suite 100
Columbus, OH 43240-4038

Phone

(614) 437-5600

Fax

(614) 437-6275

NPI assigned

Feb 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Polaris Pediatrics Inc

  • Pediatrics Physician
  • Columbus, OH
  • NPI 1609175819
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675900800000",
    "number": "1568434835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 POLARIS PKWY",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432404038",
            "telephone_number": "614-437-5600",
            "fax_number": "614-437-6275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 POLARIS PKWY",
            "address_2": "SUITE 100",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432404038",
            "telephone_number": "614-437-5600",
            "fax_number": "614-437-6275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3333 W Tech Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420955",
            "country_code": "US",
            "telephone_number": "937-641-5725",
            "fax_number": "937-350-3050",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8501 Old Troy Pike",
            "address_purpose": "LOCATION",
            "city": "Huber Heights",
            "state": "OH",
            "postal_code": "454241054",
            "country_code": "US",
            "telephone_number": "937-641-4360",
            "fax_number": "937-641-3791",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19515 Brune Pkwy",
            "address_purpose": "LOCATION",
            "city": "Warrenton",
            "state": "MO",
            "postal_code": "633836505",
            "country_code": "US",
            "telephone_number": "888-403-1071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIRVIS",
        "first_name": "BRUCE",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2023-02-09",
        "certification_date": "2023-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301116689",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2018042193",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.039260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0345086",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martha Wanjiru Miricho, RN
• Anne Mendelson Mirman-Tyser, SLP
• Cara Marie Mirras, NURSE PRACTITIONER N
• Monique Mirshak, M.D.
• Becky Gloria Mirsky, MD
• Whitney Fields Mirvis, RN, MSN,CNM, IBCIC
• Hallie Mae Mirzamani
• Grace Mischler
• Jacob Albert Misenheimer, M.D.
• Olivia C Misenheimer

• Pediatrics Physician in Columbus, OH
• Providers in Columbus, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.